Evidence map›Paper›PMID 27481305›Full record

Observational studyThe American journal of gastroenterology2016

A Rapid Bedside Screen to Predict Unplanned Hospitalization and Death in Outpatients With Cirrhosis: A Prospective Evaluation of the Clinical Frailty Scale.

Puneeta Tandon, Navdeep Tangri, Lesley Thomas, Laura Zenith, Tahira Shaikh, Michelle Carbonneau, Mang Ma, Robert J Bailey, Saumya Jayakumar, Kelly W Burak and 4 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in The American journal of gastroenterology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 107 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
107citing papers in PubMed, 6 pooled it
10.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

107 citing papers in PubMed, 6 syntheses or guidelines pooled it, 198 citations in OpenAlex.

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  15. Noninvasive Tests for Predicting Decompensation in Compensated Advanced Chronic Liver Disease: A Comprehensive Review.Liver international : official journal of the International Association for the Study of the Liver · 2026
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47 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 3 institutions in 1 country.

Puneeta TandonCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Navdeep TangriDivision of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada.
Lesley ThomasCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Laura ZenithCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Tahira ShaikhCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Michelle CarbonneauCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Mang MaCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Robert J BaileyDivision of GI, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Saumya JayakumarDivision of GI, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Kelly W BurakDivision of GI, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
Juan G AbraldesCirrhosis Care Clinic, University of Alberta, Edmonton, Alberta, Canada.
Amanda BriseboisPalliative Care, University of Alberta, Edmonton, Alberta, Canada.
Thomas FergusonDivision of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada.
Sumit R MajumdarDivision of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada.
University of Alberta · CARoyal Alexandra Hospital · CAUniversity of Manitoba · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesScreening tools to determine which outpatients with cirrhosis are at highest risk for unplanned hospitalization are lacking. Frailty is a novel prognostic factor but conventional screening for frailty is time consuming. We evaluated the ability of a 1 min bedside screen (Clinical Frailty Scale (CFS)) to predict unplanned hospitalization or death in outpatients with cirrhosis and compared the CFS with two conventional frailty measures (Fried Frailty Criteria (FFC) and Short Physical Performance Battery (SPPB)).

methodsWe prospectively enrolled consecutive outpatients from three tertiary care liver clinics. Frailty was defined by CFS >4. The primary outcome was the composite of unplanned hospitalization or death within 6 months of study entry.

resultsA total of 300 outpatients were enrolled (mean age 57 years, 35% female, 81% white, 66% hepatitis C or alcohol-related liver disease, mean Model for End-Stage Liver Disease (MELD) score 12, 28% with ascites). Overall, 54 (18%) outpatients were frail and 91 (30%) patients had an unplanned hospitalization or death within 6 months. CFS >4 was independently associated with increased rates of unplanned hospitalization or death (57% frail vs. 24% not frail, adjusted odds ratio 3.6; 95% confidence interval (CI): 1.7-7.5; P=0.0008) and there was a dose response (adjusted odds ratio 1.9 per 1-unit increase in CFS, 95% CI: 1.4-2.6; P<0.0001). Models including MELD, ascites, and CFS >4 had a greater discrimination (c-statistic=0.84) than models using FFC or SPPB.

conclusionsFrailty is strongly and independently associated with an increased risk of unplanned hospitalization or death in outpatients with cirrhosis. The CFS is a rapid screen that could be easily adopted in liver clinics to identify those at highest risk of adverse events.

Indexed as

Frail ElderlyMortalityAcute Kidney InjuryAgedCause of DeathFemaleGastrointestinal HemorrhageHepatic EncephalopathyHospitalizationHumansInfectionsLiver CirrhosisLogistic ModelsMaleMiddle AgedMultivariate Analysis

Identifiers

PMID27481305
OpenAlexW2478947510

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.